Introduction
Epilepsy is a neurological disorder associated with stigma, making it difficult for epileptic patients to manage their treatment. According to Sajatovic et al., mental health conditions (MHCs) such as severe depression, schizophrenia, or bipolar disorder affect an estimated 30% of epileptic adults. Targeted Self-Management for Epilepsy and Mental Illness (TIME) is a community evidence-based program adopted by the Centers for Disease Control and Prevention (CDC) Prevention Research Centers’ Managing Epilepsy Well (MEW). The MEW Network comprises community, academic, and public health institutions collaborating to develop, test, and disseminate evidence-based practices to improve epilepsy self-management (Sajatovic et al.). The Community TIME (C-TIME) study focused on mood symptoms in adults with epilepsy and comorbid MHCs. The primary hypothesis was that TIME would show development in depression results after 16 weeks.
Procedure
C-TIME consisted of 12 weekly sessions lasting 60-90 minutes, with a nurse and peer educators present at each session (adults with epilepsy). The nurse serves as a subject matter expert, while the peer educator represents those with firsthand knowledge (Sajatovic et al.). Personal care plans developed during these group sessions were to assist participants in meeting their objectives. The nurse called the participants two weeks later to see how they were doing with their attempts to complete plans for optimal self-management.
Participants included adults with self-reported epilepsy and MHCs who self-referred in response to Institutional Review Board (IRB) approved flyers distributed in community and clinical settings. The local IRB approved the procedures, and participants provided informed consent for collecting outcome data. Data collection included three assessment time points: baseline, three months, and four months (Sajatovic et al.). The TIME study’s standardized question formats included baseline demographics, past and current mental health conditions, substance use/abuse history, and epilepsy and mental health medication treatment.
Depressive symptom severity was measured using the rater-administered Montgomery Asberg Depression Rating Scale (MADRS) and self-reported Patient Health Questionnaire 9-item version in standardized assessments (PHQ-9). QOLIE-10-P, which includes weighting based on patient-perceived overall distress, was used to assess the quality of life. The team used the 7-item Generalized Anxiety Disorder (GAD-7) scale to assess anxiety. Participants were evaluated on their history of negative health events such as seizures to determine how C-TIME might impact the use of other available services.
Data Analysis
For the statistical analysis, the SAS 9.4 (SAS Institute, NC) test was used, with descriptive analysis looking at changes in MADRS and secondary outcomes over time. The researchers examined the change in MADRS-measured depressive symptoms from baseline to 16 weeks. For baseline to four-month comparisons, t-tests were used. The group used the analysis of variance (ANOVA) to investigate changes in depressive symptoms (MADRS, PHQ-9) and anxiety symptoms (GAD-7), as well as the quality of life over time (QOLIE-10). The Wilcoxen signed-rank test examined the progression of harmful health and resource use.
Results
Some participants were not enrolled after screening began because they did not come for the baseline evaluation. The team recruited approximately 30 adults over six months despite the many challenges (Sajatovic et al.). Referrals came from EA, clinical referrals, and the research team. Depression was the most common MHC, with anxiety disorders accounting for roughly half of all cases. Individuals had generalized seizures in the previous month. According to Sajatovic et al., over 90% of participants said they would recommend the program to others with epilepsy. The significant reduction in depression scores confirmed the hypothesis of the expected change in depressive symptoms
Conclusion
TIME can help patients improve their quality of life without using drugs. The team was able to recruit a diverse group of study participants. Despite using a small sample size of 30 people, the study discovered a significant reduction in depressive symptoms in people with epilepsy and mental illness, as well as a patient satisfaction rate of more than 90%, indicating that C-TIME could be used successfully in the community. The study found that when compared to standard treatment, depression outcomes improved.
Work Cited
Sajatovic, Martha, et al. “The Community-Targeted Self-Management of Epilepsy and Mental Illness (C-Time) Initiative: A Research, Community, and Healthcare Administration Partnership to Reduce Epilepsy Burden.” Epilepsy & Behavior, vol. 89, 2018, p. 175–180.